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Leppänen H, Kampman O, Autio R, Karolaakso T, Rissanen P, Näppilä T, Pirkola S. Socioeconomic status, psychotherapy duration, and return to work from disability due to common mental disorders. Psychother Res 2024; 34:694-707. [PMID: 37399567 DOI: 10.1080/10503307.2023.2229500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023] Open
Abstract
Objective Low socioeconomic status (SES) is a risk factor for work disability due to common mental disorders (CMDs), one possible reason being inequal use of services. Psychotherapy is an evidence-based treatment for CMDs. This study examines socioeconomic and sociodemographic differences in psychotherapy attendance and an association of psychotherapy duration with return to work (RTW).Methods The study subjects (N = 12,263) were all Finnish citizens granted a disability pension (DP) due to CMDs in 2010-2012. Numbers of psychotherapy sessions (maximum 200) were collected from the nine-year interval around the DP grant. Socioeconomic and sociodemographic differences in psychotherapy duration (dependent variable) among DP recipients were studied using multinomial logistic regression models, likewise, the association between psychotherapy duration and RTW (dependent variable) among temporary DP recipients was examined.Results Higher SES, female gender, and younger age were positively associated with attending longer psychotherapies and surpassing the early treatment termination level (>10 sessions). Attending 11-60 psychotherapy sessions was positively associated with full RTW and partial RTW, whereas longer psychotherapies were not. Early termination was positively associated with partial RTW only.Conclusion This study demonstrates varying tendencies among CMD patients from different backgrounds to attend long rehabilitative psychotherapies, which may create inequalities in RTW.
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Affiliation(s)
- Helena Leppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, The Wellbeing Services County of Pirkanmaa, Finland
| | - Olli Kampman
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, The Wellbeing Services County of Pirkanmaa, Finland
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Department of Clinical Medicine (Psychiatry), Faculty of Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, The Wellbeing Services County of Ostrobothnia, Finland
| | - Reija Autio
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Tino Karolaakso
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Päivi Rissanen
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Turkka Näppilä
- Tampere University Library, Tampere University, Tampere, Finland
| | - Sami Pirkola
- Department of Psychiatry, The Wellbeing Services County of Pirkanmaa, Finland
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
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Singer S, Wünsch A, Ihrig A, Bruns G, Holz F, Jakob J, Besseler M, Engesser D, Blettner M, König J, Bayer O. Men's Access to Outpatient Psychosocial Cancer Counseling. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:121-127. [PMID: 38231700 PMCID: PMC11019762 DOI: 10.3238/arztebl.m2024.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Men make use of outpatient cancer counseling less commonly than women, even when they stand to benefit from it. METHODS In a cluster-randomized trial (registered under DRKS00032181), we studied whether measures on multiple levels (information for referring physicians, public information, structural changes, offerings specifically for male patients) over a period of 12 months would be able to increase the percentage of men among patients seeking outpatient cancer counseling (primary endpoint, initial contact; secondary endpoint, all contacts). The intervention effect was quantified by the fitting of generalized linear mixed models to obtain an odds ratio, which was adjusted for cluster structure and for the percentages of first contacts and of all contacts during the 12 months before the start of the intervention. RESULTS In 12 regions of Germany (6 each in the intervention arm and the control arm), 11 986 people had first contacts with outpatient cancer counseling, 6004 of them during the intervention phase. The percentage accounted for by men was 30.7% in the intervention arm and 25.7% in the control arm, corresponding to a statistically insignificant model-based adjusted odds ratio (OR) of 1.2 (95% confidence interval [1.0; 1.4], p = 0.08) for the primary endpoint. There were a total of 51 842 counseling sessions (both initial contacts and subsequent contacts), 26 651 of them in the intervention phase. The percentage of these that was accounted for by men was 27.6% in the intervention arm and 22.2% in the control arm; the adjusted OR for this secondary endpoint was 1.3 [1.1; 1.6], p = 0.01). CONCLUSION The targeted implementation of malespecific measures on multiple levels can increase, by a small amount, the percentage of men among persons seeking outpatient cancer counseling.
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Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Hospital Mainz
- University Cancer Center Mainz (UCT), Johannes Gutenberg University of Mainz
| | - Alexander Wünsch
- Psycho-Oncological Service, Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
- Freiburg Cancer Counseling Service, Comprehensive Cancer Center Freiburg (CCCF) in cooperation with the Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Medical Faculty, Albert Ludwigs University of Freiburg
| | - Andreas Ihrig
- North Baden Psychosocial Cancer Counseling Service, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg
| | - Gudrun Bruns
- Tumor Network Cancer Counseling in the Münster Region, Münster
| | - Franziska Holz
- Cancer Counseling Service of the Hamburg Cancer Society, Hamburg
| | - Johannes Jakob
- Cancer Counseling Service of the phönikks Foundation, Hamburg
| | - Markus Besseler
- Munich Psychosocial Cancer Counseling Service of the Bavarian Cancer Society, Munich
| | - Deborah Engesser
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Hospital Mainz
| | - Maria Blettner
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Hospital Mainz
| | - Jochem König
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Hospital Mainz
| | - Oliver Bayer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Hospital Mainz
- University Cancer Center Mainz (UCT), Johannes Gutenberg University of Mainz
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Selinheimo S, Gluschkoff K, Kausto J, Turunen J, Väänänen A. Sociodemographic Factors as Predictors of the Duration of Long-term Psychotherapy: Evidence from a Finnish Nationwide Register Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:35-46. [PMID: 37828416 PMCID: PMC10791957 DOI: 10.1007/s10488-023-01305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE The role of sociodemographic factors in determining psychotherapy duration has been largely unexplored despite their known association with treatment use. We examined the association between sociodemographic factors and rehabilitative psychotherapy treatment duration, as well as any changes in duration over time. METHOD We used three register-based nationally representative cohorts. Participants included employed Finnish individuals (n = 5572, 77% women, mean age = 37) who started psychotherapy treatment in 2011, 2013 or 2016 and were followed until 2019. We used negative binomial regression to examine the association between sociodemographic factors (age, gender, education, occupational status, income, geographical area of residence, and onset year of treatment) with treatment duration. RESULTS The mean treatment duration was 27 months (with a standard deviation of 12 months). Several sociodemographic factors were associated with treatment duration. Gender and education were found to have the largest impact on treatment duration, with females having a longer duration (IRR 1.08, 95% CI 1.04-1.11) and those with low education having a shorter duration (IRR 0.91, 95% CI 0.85-0.97), resulting in a difference of 2-3 months. Treatment duration also increased in later years, which suggests potentially increasing differences in treatment implementation. At largest, the combined effect of all factors corresponded to a 10-month difference in treatment duration. CONCLUSIONS The duration of long-term psychotherapy varied across the sociodemographic groups and increased in all studied groups in the 2010s.
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Affiliation(s)
| | - Kia Gluschkoff
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Johanna Kausto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jarno Turunen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Walther A, Rice T, Eggenberger L. Precarious Manhood Beliefs Are Positively Associated with Erectile Dysfunction in Cisgender Men. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3123-3138. [PMID: 37351710 PMCID: PMC10684399 DOI: 10.1007/s10508-023-02640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
The notions that manhood is hard to attain, easy to lose, and needs to be proven via public action constitute precarious manhood beliefs (PMB). PMB is a new concept and it remains unclear whether and how PMB relate to erectile dysfunction (ED) in cisgender men. The ability to achieve an erection remains considered as a cornerstone of masculinity and sexual performance can be conceived as a proof of one's masculinity. In this context, ED can be received as sexual failure and a threat to a man's masculinity and sense of adequacy. For these reasons, the hypothesis that PMB are associated with ED warranted empirical testing. In an anonymous online survey focusing on men's mental health conducted in German-speaking countries of Europe, 507 cisgender men (Mage = 44.2, SDage = 15.2) completed measures on PMB, sexual function, self-stigma, social desirability, and conformity to traditional masculinity ideology (TMI). Multilinear regression analysis with stepwise introduction of relevant covariates evaluated potential associations between PMB and ED. Of a 507 cisgendered male sample, 63.1% reported an increased risk for ED based on previously established cutoff points. Elevated levels of PMB endorsement among the men predicted reduced sexual and erectile function in all models, even when accounting for relevant control variables such as age, education, self-stigma, social desirability, or conformity to TMI. Group comparisons revealed that the men suffering from ED showed higher levels of PMB endorsement but not self-stigma nor TMI relative to men without ED. PMB are significantly associated with ED. While determining causality will require further study, our results may support the hypothesis that higher levels of PMB endorsement may lead to increased tension to perform sexually, resulting in increased psychological pressure and a higher risk to develop ED.
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Affiliation(s)
- Andreas Walther
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmühlestrasse 14, 8050, Zurich, Switzerland.
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lukas Eggenberger
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmühlestrasse 14, 8050, Zurich, Switzerland
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Hofmann L, Wagner B. Men's Behavior and Communication in the Days Prior to a Suicide-A Psychological Autopsy Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6668. [PMID: 37681808 PMCID: PMC10488060 DOI: 10.3390/ijerph20176668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
Men show a significantly higher suicide rate, are less often recognized as persons at risk, and are more difficult to reach for suicide prevention interventions. Warning signs and deterioration in mental health are often not recognized by their surroundings. This study aims to retrospectively analyze the behavior and communication of men before a suicide, how relatives noticed changes, and how the interaction was perceived. N = 15 individuals who lost a close male relative to suicide were interviewed using psychological autopsy interviews. The interviews were evaluated following a deductive-inductive approach while using a comprehensive category system. The majority of men showed changes in behavior before the suicide, especially social withdrawal, irritability, and generally a deterioration in mental health. In fact, men did communicate their suicidal thoughts before they died through suicide, but mainly indirectly. While only one-third of the deceased made preparations before suicide, the majority of relatives noticed a deterioration in the mental health of the individual as well as increased alcohol and substance use. Men show signs of suicide, which are little recognized by their surroundings. Suicide prevention interventions should be adapted more to the needs of men.
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Affiliation(s)
- Laura Hofmann
- Department of Clinical Psychology, Medical School Berlin, 14197 Berlin, Germany;
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Krumm S, Krieg G, Lamp N, Marek F, Nickel P, Panzirsch M, Stiawa M, Beschoner P, Brieger P, Frasch K, Gertzen M, Gündel H, Hasan A, Jäger M, Kling-Lourenco P, Koussemou JM, Steber R, Kilian R. The transformation of masculinity orientations and work-related attitudes in men treated for depression (TRANSMODE): study protocol for a mixed-methods observational study. BMC Psychiatry 2023; 23:492. [PMID: 37430236 DOI: 10.1186/s12888-023-04979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Masculinity norms play a crucial role in men's help-seeking behaviors, service-use, and coping strategies for depression. While previous studies provided evidence for the association between gender role orientations, work related attitudes, stigmatization of men with depression and depressive symptoms, it remains unclear to what extent gender role orientations change over time and whether psychiatric and psychotherapeutic treatment have an impact on these transformations. Additionally, the role of partners in supporting depressed men and the impact of dyadic coping on these processes have not been explored. The aim of this study is to investigate how masculinity orientations and work-related attitudes change over time in men treated for depression, and to examine the role of their partners and dyadic coping in these transformation processes. METHODS TRANSMODE is a prospective longitudinal mixed-methods study investigating the transformation of masculinity orientations and work-related attitudes in men treated for depression between the ages of 18 and 65 from different settings in Germany. The study will recruit 350 men from various settings for quantitative analysis. By applying a latent transition analysis, the primary outcome are changes in masculine orientations and work-related attitudes over time, measured at four times (t0, t1, t2, t3) with intervals of 6 months. Qualitative interview with a subsample of depressed men selected using latent profile analysis, will be conducted between t0 and t1 (a1) with a follow-up of 12 months (a2). In addition, qualitative interviews with the partners of depressed men will be conducted between t2 and t3 (p1). Qualitative data will be analysed using qualitative structured content analysis. DISCUSSION A comprehensive understanding of the transformation processes of masculinity orientations over time including the impact of psychiatric/psychotherapeutic treatment and the role of partners can lead to the development of gender-sensitive depression treatment tailored to the unique needs of men with depression. Thus, the study can promote more effective and successful treatment outcomes and further contribute to reducing the stigma surrounding mental health issues among men and encourage them for mental health service use. TRIAL REGISTRATION This study is registered in the German Clinical Trail Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00031065 (Date of registration 06 February 2023).
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Affiliation(s)
- Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany.
| | - Gironimo Krieg
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Natalie Lamp
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Franziska Marek
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Paul Nickel
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Maria Panzirsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Donauwörth, Donauwörth, Germany
| | - Maja Stiawa
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Christophsbad Clinic, Göppingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | | | - Karel Frasch
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Donauwörth, Donauwörth, Germany
| | - Marcus Gertzen
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Alkomiet Hasan
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | | | | | - José Marie Koussemou
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Heidenheim Clinic, Heidenheim, Germany
| | | | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
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Walther A, Ehlert U, Schneeberger M, Eggenberger L, Flückiger C, Komlenac N, Heald A, Rice T, Palm S, Seidler ZE, Ogrodniczuk JS, Oliffe JL, Rice SM, Kealy D, Weber R, Zimmermann D. Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone. Front Psychiatry 2023; 14:1129386. [PMID: 37415687 PMCID: PMC10321526 DOI: 10.3389/fpsyt.2023.1129386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/02/2023] [Indexed: 07/08/2023] Open
Abstract
Background Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). Aim This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. Methods The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. Expected results Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. Discussion This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men. Clinical Trial Registration ClinicalTrials.gov, identifier NCT05435222.
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Affiliation(s)
- Andreas Walther
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Michèle Schneeberger
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Lukas Eggenberger
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | | | - Nikola Komlenac
- Institute of Diversity in Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Adrian Heald
- Department of Endocrinology, University of Manchester, Manchester, United Kingdom
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Simona Palm
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Zac E. Seidler
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John S. Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Simon M. Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rainer Weber
- Faculty of Medicine and University Hospital Cologne, Clinic and Polyclinic for Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - David Zimmermann
- Andrology and Urology Centre, Uroviva Network, Zurich, Switzerland
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Logoz F, Eggenberger L, Komlenac N, Schneeberger M, Ehlert U, Walther A. How do traditional masculinity ideologies and emotional competence relate to aggression and physical domestic violence in cisgender men? Front Psychol 2023; 14:1100114. [PMID: 36998370 PMCID: PMC10043379 DOI: 10.3389/fpsyg.2023.1100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/22/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundMen are disproportionately often perpetrators of physical domestic violence (DV). Gender role constructs, such as traditional masculinity ideologies (TMI), are broadly accepted as an explanation for this effect. Emotional competence further constitutes an important role in TMI and the prevention of DV. However, the interactions between these constructs remains unclear.ObjectiveThe present study aims to investigate associations of TMI with aggression, DV perpetration, and emotional competence, while also examining emotional competence as a potential moderator.MethodA sample of 428 cisgender men (Mage = 43.9 ± 15.3) from German-speaking countries in Europe completed an anonymous online survey that assessed TMI, aggression, and DV perpetration as well as alexithymia, emotion regulation, and self-compassion as indicators of emotional competence.ResultsStrong TMI were associated with high levels of aggression and overall reduced emotional competence, as reflected by high levels of alexithymia, frequent use of expressive suppression, and low levels of self-compassion. Strong conformity to TMI was associated with a higher likelihood for DV perpetration when considering relevant sociodemographic covariates. Moderation analyses revealed that expressive suppression buffered the association between TMI and DV perpetration.ConclusionMen with strong TMI report high levels of aggression and impaired emotional competence. While strong conformity to TMI was associated with more frequent perpetration of DV, higher expressive suppression seems to buffer the association between TMI and DV perpetration. The present study highlights the importance of addressing gender ideologies when working on aggression, DV perpetration and emotional competence in men.
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Affiliation(s)
- Flora Logoz
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zürich, Switzerland
| | - Lukas Eggenberger
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zürich, Switzerland
| | - Nikola Komlenac
- Institute of Diversity in Medicine, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Michèle Schneeberger
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zürich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zürich, Switzerland
| | - Andreas Walther
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zürich, Switzerland
- *Correspondence: Andreas Walther,
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Claudio D, Moyce S, Albano T, Ibe E, Miller N, O’Leary M. A Markov Chain Model for Mental Health Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3525. [PMID: 36834220 PMCID: PMC9961139 DOI: 10.3390/ijerph20043525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Poor mental health affects nearly one billion people worldwide and can end in suicide if not treated. Unfortunately, stigma and a lack of mental healthcare providers are barriers to receiving needed care. We developed a Markov chain model to determine whether decreasing stigma or increasing available resources improves mental health outcomes. We mapped potential steps in the mental health care continuum with two discrete outcomes: getting better or committing suicide. Using a Markov chain model, we calculated probabilities of each outcome based on projected increases in seeking help or availability of professional resources. Modeling for a 12% increase in awareness of mental health concerns yielded a 0.39% reduction in suicide. A 12% increase in access to professional help yielded a 0.47% reduction in suicide rate. Our results show that expanding access to professional services has a higher impact on reducing suicide rates than creating awareness. Any intervention towards awareness or access positively impacts reducing suicide rates. However, increased access results in a higher reduction in suicide rates. We have made progress in increasing awareness. Awareness campaigns help to increase recognition of mental health needs. However, focusing efforts on increasing access to care may have a higher impact on reducing suicide rates.
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Affiliation(s)
- David Claudio
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Sally Moyce
- College of Nursing, Montana State University, Bozeman, MT 59717, USA
| | - Tyler Albano
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Ekeoma Ibe
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Nick Miller
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Marshall O’Leary
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
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Eggenberger L, Ehlert U, Walther A. New directions in male-tailored psychotherapy for depression. Front Psychol 2023; 14:1146078. [PMID: 37143589 PMCID: PMC10151934 DOI: 10.3389/fpsyg.2023.1146078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose of review Societal, cultural, and contextual norms about how men should be and behave (so called traditional masculinity ideologies; TMI) affect men's presentation of depressive disorders, psychotherapy use, and treatment engagement. Only recently, however, male-tailored psychotherapy approaches for depressive disorders have been developed, which aim to systematically soften dysfunctional TMI. In this review, we outline the necessary groundwork as well as recent advances in research on TMI, men's help-seeking, male depression, and their interrelatedness. Subsequently, we discuss the potential value of these findings for male-tailored psychotherapy for depressive disorders. Recent findings A preliminary evaluation of a male-specific psychoeducation program found that a male-specific psychoeducation text could reduce negative affect as well as state shame and potentially elicit a shift from externalizing depression symptoms toward more prototypical depression symptoms. The James' Place program, a male-tailored community-based service, improved suicidal men's overall well-being, problems, functioning, and suicide risk. The Heads Up Guys! program, an eHealth resource aimed at depressed men, reported a high and increasing global interest in their website, with considerable visitor engagement. The Man Therapy online resource improved depressive symptoms, suicidal ideation, and help-seeking behavior. Finally, the Men in Mind program, an online training program for clinical practitioners, increased practitioners' capacity to engage and support men in therapy. Summary Male-tailored psychotherapy programs for depressive disorders, which are informed by recent advances in TMI research, may potentially increase therapeutic effectiveness, engagement, and adherence. While recent preliminary analyses of individual male-tailored treatment programs show promising results, extensive and systematic primary studies evaluating these programs are pending but greatly needed.
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Storey QK, Kealy D, Seidler ZE, Oliffe JL, Rice SM, Ogrodniczuk JS. Connecting and Healing: The Role of Existential Isolation in Mediating the Impact of the Therapeutic Relationship on Canadian Men's Mental Health Outcomes. Am J Mens Health 2022; 16:15579883221136980. [PMID: 36373408 PMCID: PMC9663642 DOI: 10.1177/15579883221136980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The therapeutic relationship has emerged as one of the most important components of successful treatment outcomes, regardless of the specific form of therapy. Research has now turned its attention to better understanding how the therapeutic relationship contributes to patient improvement. Extant literature contends that a strong therapeutic relationship may help reduce a patient's sense of existential isolation (i.e., a sense of not feeling understood by others). Research indicates that existential isolation might be especially problematic for men, potentially increasing their risk for suicidality. This study investigated the association between strength of the therapeutic relationship and psychological distress and suicidality among men who received psychotherapy, and whether existential isolation mediated this association. A total of 204 Canadian men who had previously attended psychotherapy participated in a cross-sectional survey, completing measures of the quality of their most recent therapeutic relationship, existential isolation, depression and anxiety symptoms, and suicidality. Regression with mediation analysis was conducted. Two models were tested; one with depression/anxiety symptoms as the dependent variable and the other with suicidality as the dependent variable. Both mediation models emerged as significant, indicating an indirect effect for quality of the therapeutic relationship on symptoms of anxiety/depression and suicidality through existential isolation. The findings suggest that a positive therapeutic relationship can contribute to men feeling less isolated in their experiences in life (i.e., less existentially isolated), thereby helping mitigate psychological distress and suicidality.
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Affiliation(s)
- Quinn K. Storey
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zac E. Seidler
- Orygen, Melbourne, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia,Movember Foundation, Melbourne, Victoria, Australia
| | - John L. Oliffe
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon M. Rice
- Orygen, Melbourne, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John S. Ogrodniczuk
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada,John S. Ogrodniczuk, Department of Psychiatry, The University of British Columbia, 420-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z4.
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Gender Differences in Attachment Anxiety and Avoidance and Their Association with Psychotherapy Use—Examining Students from a German University. Behav Sci (Basel) 2022; 12:bs12070204. [PMID: 35877274 PMCID: PMC9312160 DOI: 10.3390/bs12070204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Attachment anxiety and avoidance might explain gender differences in psychotherapy use, which is generally lower in men. In addition, university students are a particularly vulnerable group for mental health problems, and understanding psychotherapy use, especially among mentally distressed male students, is pivotal. A total of 4894 students completed an online survey answering questions regarding psychotherapy use and completing the PHQ-D identifying psychological syndromes. In addition, the ECR-RD12 was used to measure attachment anxiety and avoidance. Significant gender differences for attachment anxiety and avoidance emerged, showing higher attachment anxiety in female students and higher attachment avoidance in male students. Male students used psychotherapy significantly less than female students. Male students’ attachment anxiety and avoidance predicted psychotherapy use, while for female students, only attachment anxiety emerged as a significant predictor. Attachment anxiety is positively associated with psychotherapy use, and lower attachment anxiety in men may explain lower psychotherapy use in male students.
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Powers-James C, Christie AJ, Narayanan S, Liu W, Gomez T, Cohen L, Lopez G. Frequencies and predictors of health psychology referrals after integrative oncology consultation. Support Care Cancer 2022; 30:6963-6972. [PMID: 35545723 PMCID: PMC9095439 DOI: 10.1007/s00520-022-07105-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
Objective Health psychology (HP) plays a critical role within a multidisciplinary, integrative oncology team. HP in integrative oncology is not well established and criteria for referral have not been examined. This study examined characteristics of referral to HP. Methods A chart review of 1827 patients in the Integrative Medicine Center (IMC) between 2019 and 2020 was conducted. Patient assessments included the Edmonton Symptom Assessment Scale, Measure Yourself Concerns and Well-being, and PROMIS10. Chi-square tests were used to compare categorical variables, Mann-Whitney test for non-normally distributed continuous variables, and t-tests for normally distributed continuous variables comparing those referred and not referred to HP. Results Patients referred (n = 316) were mostly female (85.4%), White (67.1%), married/partnered (67.7%), obese (42.1%), and with breast cancer (52.2%). When comparing the two groups, patients referred to HP and patients not referred to HP, patients referred had a higher proportion of female and Black patients than expected (p ≤ .01); patients referred were also younger and had higher BMIs (p ≤ .01). Referred patients reported worse fatigue, sleep, depression, anxiety, well-being, spiritual pain, financial distress, memory, overall mental health, physical health, and global health (p ≤ .01). Most common concerns of referrals were diet/nutrition, overall health, and stress/anxiety. Compared to non-referred, HP referrals were more likely to prioritize depression, spirituality, and stress/anxiety (p ≤ .01). Conclusions Patient characteristics are well-suited treatment targets for HP, including addressing emotional distress, healthy lifestyle, and quality of life. Our findings can help programs develop strategies to facilitate engagement with psychological counseling.
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Affiliation(s)
- Catherine Powers-James
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
| | - Aimee J Christie
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Wenli Liu
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Telma Gomez
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA
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Walther A, Eggenberger L, Grub J, Ogrodniczuk JS, Seidler ZE, Rice SM, Kealy D, Oliffe JL, Ehlert U. Examining the Role of Traditional Masculinity and Depression in Men's Risk for Contracting COVID-19. Behav Sci (Basel) 2022; 12:80. [PMID: 35323399 PMCID: PMC8945728 DOI: 10.3390/bs12030080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
In the light of the COVID-19 pandemic and claims that traditional masculinity may put some men at increased risk for infection, research reporting men's health behaviors is critically important. Traditional masculine norms such as self-reliance and toughness are associated with a lower likelihood to vaccinate or follow safety restrictions. Furthermore, infection risk and traditional masculinity should be investigated in a differentiated manner including gender role orientation, underlying traditional masculine ideologies and male gender role conflict. In this pre-registered online survey conducted during March/April 2021 in German-speaking countries in Europe, 490 men completed questionnaires regarding contracting COVID-19 as confirmed by a validated test, fear of COVID-19 (FCV-19S), and experience of psychological burden due to COVID-19. In addition, depression symptomatology was assessed by using prototypical internalizing and male-typical externalizing depression symptoms. Furthermore, self-identified masculine gender orientation, endorsement of traditional masculinity ideologies, and gender role conflict were measured. A total of 6.9% of men (n = 34) reported having contracted COVID-19 since the beginning of the pandemic. Group comparisons revealed that men who had contracted COVID-19 exhibited higher overall traditional masculine ideology and gender role conflict. Logistic regression controlling for confounders (age, income, education, and sexual orientation) indicated that only depression symptoms are independently associated with the risk of having contracted COVID-19. While prototypical depression symptoms were negatively associated with the risk of having contracted COVID-19, male-typical externalizing depression symptoms were positively associated with the risk of contracting COVID-19. For traditional masculinity, no robust association for an increased risk of contracting COVID-19 could be established, while higher male-typical externalizing depression symptoms were associated with an increased risk of contracting COVID-19.
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Affiliation(s)
- Andreas Walther
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
| | - Lukas Eggenberger
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
| | - Jessica Grub
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
| | - John S. Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (J.S.O.); (D.K.)
| | - Zac E. Seidler
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia; (Z.E.S.); (S.M.R.)
- Orygen, Melbourne, VIC 3052, Australia
| | - Simon M. Rice
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia; (Z.E.S.); (S.M.R.)
- Orygen, Melbourne, VIC 3052, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (J.S.O.); (D.K.)
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Department of Nursing, University of Melbourne, Parkville, VIC 3010, Australia
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
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